Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-29

TRANSITION FROM PEDIATRIC TO ADULT CARE

The transition years from adolescence to early adulthood are the most difficult years to maintain good glycemic control (18,36). With numerous changes occurring in a rapid sequence and so many competing interests, it is easy to understand how diabetes management becomes suboptimal and patients become disengaged from their support (57,58). However, this is also the age where there is an increase in the incidence of acute complications, such as DKA, and chronic complications can begin to develop (18,36). This is an age that needs more support rather than less!

Goal : Safely navigate through this age helping the adolescent develop skills and attitudes to foster the development of healthy self-care behaviours.

As the 2018 Guidelines state, the transition of care from the pediatric team to the adult medical team requires discussion and careful planning (4,8,10,36,58). We need to recognize the fundamental differences in the way we deliver care to this population. In adult centers, the focus changes from the family-centered collaborative pediatric visits with extensive parental involvement, to a focus on the individual with emphasis on self management and self-reliance (59). Where previously the information was shared with the family, confidentiality becomes an issue and permission must be granted to include the family in the visit (57). The medical visits in the adult centre may become shorter in duration, more directed, and require the patient to become more proactive in their care ( 58,60). Adjusting to these changes is often difficult for the adolescent who may be ill equipped to take on any additional challenges. Where previously he/she felt comfortable and secure, he/she may now feel uncomfortable and confronted with the responsibilities of his/her diabetes management. Research into the best methods/strategies to employ for successful transition from pediatric to adult care suggests that (36,57-60): • Transition care should start early, with a minimum of a year prior to transfer. • As the adolescent is growing and developing, there should be a shift in diabetes education from the parents to the teen.